Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | 036-150555 | IL |
NPI | 1043248503 |
---|---|
Provider Name | Dr. Elias M Michaelides |
First Address | Chicago, IL 60612-4861 |
Second Address | Chicago, IL 60612 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2006 |
Last Update Date | 22/08/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B M6294312 | DEA SUBSTANCE REG. (01) | CT |